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r <br /> tLATORING WELL INSTAU ATION REP01c1 - <br /> } <br /> Date: 1'Lu�`� :Y CONSTRUC'T'ION <br /> Premise Address. 3 Total Depth 35' <br /> r Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 3 _(to) <br /> Bentonite (from) 3 (to) ! <br /> Inspector: Grout (from) <br /> Drilling rig type <br /> Permit No. Auger O.D. _ I.D. <br /> r Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant 6 T <br /> ' T <br /> Geologist _— <br /> ABOVE-GROUND CHR1M_Sox <br /> COMPLETION .. COMPLETION <br /> SPECIAL PERMIT INFO.Surfacs <br /> 7 grout <br /> Distance to sewer line <br /> � Y <br /> Domestic well on site - <br /> If yes, location and distance - <br /> %;z <br /> rlk�` <br /> r e ¢V <br /> SAMPLING ,�,c� slotted <br /> +.` <br /> &ocdoa <br /> x,Holdmg Temper tore <br /> 1 C... F <br /> 4 P <br /> ark <br /> Method. w <br /> ` Screening Method ` <br /> 'x Tracking Sheet (X 'n.} - <br /> r - , <br /> ,SPOILS <br /> Storage Method �/r'y""' o"'- ` MATERIALS/DEVELOPMEN-E <br /> ` Contamunati ni'Noted ( n y.�cRVStorage Locatioin.I31 1 C%� Casing type <br /> �°' Blank__j5___ ftScreen 4-0 ft. <br /> Slot size • 610GROUTING Bags cement. *` <br /> Buckets bentonite r` <br /> Depth to:waterc <br /> Bags,sand/gravel• •, <br /> s <br /> Mix Ratios Filter Pack type/si e <br /> Installation Method Surge Block: - n ) <br /> Quantity:lnstalled",e ' Discussed with geologist: - n ) J' <br /> Type of method , <br /> EH 29 29 <br /> - r er ., <br />